Psychological costs of war: Military combat and mental health

Due to the intense nature and duration of the post-9/11 conflicts, the United States has needed to help an increasingly large pool of veterans who require long-term medical and mental health care. More than 1 million Americans served in the Iraq war alone.

A 2011 study from Georgia State University and San Diego State University, “The Psychological Costs of War: Military Combat and Mental Health,” analyzed data from the National Longitudinal Study of Adolescent Health, focusing on the experiences and health outcomes of 1,100 young servicemen and women. The researchers examined the relationship between experiences of violence and direct combat in Iraq, Afghanistan and other theaters of the “global war on terrorism,” and rates of psychological counseling, post-traumatic stress disorder (PTSD) and suicide. Ultimately, the researchers sought to estimate the mental health care costs for affected veterans over a two-year period.

The study’s findings include:

Those serving in combat were 7.3 percentage points more likely to receive counseling and 12.1 percentage points more likely to receive a PTSD diagnosis than their active-duty counterparts in non-combat zones. Those serving more than 12 months in a combat zone were 14.3 percentage points more likely to be diagnosed with PTSD than those who served less than one year.

Experiencing an enemy firefight was associated with a 10.4 percentage point increase in the likelihood of suicidal thoughts and an 18.3 percentage point increase in the probability of PTSD. Additionally, for troops who believed they had killed someone there was a 12 percentage point increase in the probability of suicidal thoughts and a 22.2 percentage point increase in the likelihood of PTSD, compared to rates for service members who did not believe they had killed another person.

Being wounded or injured in combat was associated with a 27.5 percentage point increase in the probability of receiving counseling and a 23.9 percentage point increase in the likelihood of a PTSD diagnosis.

For the 2.16 million U.S. troops deployed in combat zones between 2001 and 2010, the total estimated two-year costs of treatment for combat-related PTSD are between $1.54 billion and $2.69 billion.

The authors note in their conclusion that the estimated costs are likely conservative and do not account for the full range of effects that will unfold for the veterans population: “It is important to keep in mind that our cost estimates are lower-bound estimates of health care costs because they represent costs only for younger soldiers measured in the short-run. Moreover, our costs do not capture the effects of combat-induced adverse mental health on future labor market, marriage and other socioeconomic outcomes.”